Dr RICHARD's Desk - 2007

Obesity vs StarvationWe have all heard the dire predictions of the world not being able to produce enough food to feed an increasing population.

Well the opposite has happened: World-wide the number of overweight people now exceeds the number of starving people

In fact the gap is widening as obesity continues to grow quickly and under-nutrition drops slowly.

USA and Obesity
The proportion of severely obese Americans - at least a whopping 45 kg or 7 stone overweight - has quadrupled since 1986

It is predicted 80% of Americans will be obese by 2040.

Are you overweight ? How do I check if I am overweight ?

Easy

1. Look in the mirror after a shower

2. Measure your waist circumference

Males:

a waist >102 cm - obese

> 94 cm - overweight

Females:

a waist >88 cm - probably obese

>80 cm probably overweight

These values are closely associated with an increased risk of heart disease and diabetes.

Incidentally US Researchers found people who frequently attend a religious service are likely to be fatter than everyone else !By contrast, little old ladies of European descent who only attended church once per week were more likely to be slim.

Well at least you still have one good leg ! ! ! "Just make sure they operate on the right bit !" Often spoken not only in jest.

In one USA study over a 20 year period and about 2.8 million operations only 25 were in the wrong place!Only in one case was permanent significant injury caused

Great care is obviously taken to make sure the correct part is operated on.

Sometimes it is partly a patient error: A Brazilian man who attended a clinic seeking to have his ear-ache treated ended up having a Vasectomy. The man entered the Vasectomy Room mistakenly thinking he had been called to the Ear Clinic

The patient later explained he thought hisear-ache was caused by an infection which had spread to his testicles.The patient who had two children did not want the vasectomy reversed

Oral Rehydration as Good as IV HydrationDiarrhoea in children is very common and can be a serious, life threatening infection. Dehydration is the very real danger especially in small children and babies.

Medical attention should always be sought except for very minor cases

Rehydration is the basis of treatment and is crucial
Evidence continues to support very strongly the use of Oral Rehydration Therapy (ORT). In fact ORT has been claimed by some to be one of the greatest medical advances of the last century.

Again recent research confirms ORT is as effective as Intravenous Therapy and does not have the cost, technical equipment and skill requirements needed for IV Therapy. Anybody can give ORT.No medical or nursing training is necessary.

It is worthwhile having a few packets of ORT at home. Start using ORT immediately your child develops diarrhea or vomiting

Is Rugby a Dangerous Sport ? ? ?
Apart from the inevitable physical injuries which occur in any contact sport there has always been some concern there may be long term cognitive effects from heads being in too many scrums and rucks in rugby.

There are no objective data supporting that concern, but there is some unscientific evidence taken from the cream of New Zealand rugby:

» I owe a lot to my parents ,especially my mother and father – Tana Umaga » That kick was absolutely unique, except for the one before it which was identical – Tony Brown » I'm going to graduate on time, no matter how long it takes – Rodney So’ialo » Nobody in rugby should be called a genius. A genius is a guy like Norman Einstein – Jono Gibbs » I've never had major knee surgery on any other part my body – Jerry Collins » Well, either side could win it, or it could be a draw – Murray Mexted » You guys pair up in groups of three, then line up in a circle – Hurricanes coach

Sterilisation - Vasectomy or Tubal LigationContraception is a problem for everybody at some time in their life. The various contraception options are reasonable but could be better.
Permanent contraception is often considered after your family is complete. The choice is either Vasectomy in males or Tubal Ligation in women.

You should be over 30 years, absolutely certain your family is complete and be comfortable with the concept that reversibility is not likely. Technically reversibility may be possible but there is a very good chance fertility will not return to normal levels especially over time. If you think you might have a sterilization procedure and then reverse it later if you change your mind then do not go ahead with it.Vasectomy involves removal of a short length of the Vas Deferens and tying or cauterisng (burning) the ends or the remaining tube. The Vas Deferens is a hollow tube which transports the sperm from the testicle to the penis. Vasectomy simply blocks sperm from moving along the tube.

Tubal Ligation in women involves the same concept but the Fallopian Tubes which carry the ovum or egg from the ovaries to the uterus is blocked

Male Sterilisation(Vasectomy)

Female Sterilisation (Tubal Ligation)

EFFECTIVENESS

Very effective but slightly higher rate of spontaneous recanalisation and pregnancy.
Effective 6-10 weeks after surgery

Very effective,slightly lower failure rate.
Effective immediately

COMPLICATIONS

Procedure involves almost no risk of internal injuries & other life threatening complications. Slight possibility of serious infection
No anaesthesia-related deaths

Procedure involves a slight risk of injuries & other life threatening serious internal injury or other life threatening complications

ACCEPTABILITY

Minute scars. Slightly more reversible.
Less expensive

Scars are very small but still visible. Slightly less reversible. More acceptable in many cultures

PERSONNEL

Can be performed by one trained person with or without an assistant. Can safely be performed in half the time of most female sterilisations

Needs a surgeon, anaesthetist, nurses, and a hospital operating theatre. Can safely be performed in half the time of most Usually only a gynaecologist can perform laparoscopic sterilisation. Open sterilisation is simpler

EQUIPMENT

No special back-up facilities needed

Very expensive, complex equipment is used for laparoscopic sterilisation. Standard surgical equipment is required for open sterilisation. General anaesthesia is necessary

BACK-UP FACILITIES

No special back-up facilities needed
Home immediately after vasectomy

Full post-operative hospital back-up facilities necessary in case of surgical or anaesthetic complications.
May need an overnight hospital stay

POSSIBLE LONG TERM SIDE EFFECTS

None demonstrated. Uncertainty about increase in sperm antibodies

Slightly increased risk of ectopic pregnancy

Whatever your choice, be certain you are happy that the procedure is permanent

The day after the night before
The effects of a night of social drinking can linger long after the party is over. The anecdotal guidelines of " eight hours from bottle to throttle " is not valid, according to new data.

These negative effects surprisingly continue the next day despite blood alcohol level having returned to zero !!This has relevance to all workers and students but especially those in potentially dangerous jobsBlood donorsCzech blood authorities have boosted blood donations by promising patrons two beers in exchange for one blood donation. WHO recently recommended the country do more to curb alcoholism

Traffic Problems and Heart Attack: German researchers found the risk of Heart Attack in susceptible patients increased significantly one hour after they were exposed to traffic, whether they were traveling by car, bicycle, motorcycle or public transport.

A combination of stress, noise and traffic-related air pollution were blamed. All sound familiar ?

War and Disease
In the Napoleonic Wars eight times more men died from disease than battle injury.

Diarrhoeal disease is the biggest infection problem armies face and the biggest user of manpower. At El Alamein in WW II about 40 -50% of Italian and German troops had dysentery. In the Korean War 55% of USA troops developed diarrhea within 6 weeks of arrival.

What about modern times? In the Gulf War there were 50-100 cases of diarrhoea per 1,000 personnel.

Anybody who has had severe diarrhea let alone dysentery would know just how easy it is to lose enthusiasm for anything, let alone marching to war.

What's in a Word
Most know the word " doctor " really means " teacher ". Originally it was a title of courtesy and respect bestowed on learned men.(I liked that !) Only about 300 years ago did it come to mean a purveyor of medical knowledge.

Presumably that was an improvement on 1300 BC, when the word "leech" was used to designate a doctor.

Did you hear about . . . . . . . . Viagra Marketing Have you heard of Viagra, Celebrex or Xenical ?You have ? . . . . Then you will realize just how effective the new technique of direct -to- consumer pharmaceutical marketing has become in NZ and USA where it is legal. It is not legal in Australia

Prescription-only drugs were originally promoted through medical literature and doctors only.

This new marketing technique influences patients to request prescription–only drugs by brand name during medical consultations . . . . and they do !

Well is it effective marketing ?NZ data show $US 2million on promotion contributes up to a 42% increase in prescribing volume of that drug

Why did my child come to see you today?
A not unusual phone call many doctors get from well meaning, concerned parents who were unaware their child was seeking medical advice.Basically the doctor is legally unable to answer the parents' question. Issues of patient care, consent, privacy law and child protection law are involved. The issue can certainly generate understandable parental aggravation.

The options will depend on the view of the patient,the age of the patient, the patient’s maturity and the reason for consultation especially if it involves risk behaviour

If the patient has the maturity to understand the issues and tells the doctor not to tell their parentsthen the doctor cannot tell the parents.

Clearly if the doctor felt it would be helpful to the child if parents were told then the doctor should discuss this with the patient and seek their agreement to tell the parents. Perhaps the child would agree to someone other than parents being told.

If the child is at riske.g. abuse of some sortthen the doctor is by law obliged to inform the relevant child protection agency

The reality is this problem is usually resolved satisfactorily to all parties. Medico legal issues are becoming increasingly intrusive in medical practice.

"Wrongful Life” and Legal Action
Recently there have been more legal cases suing for damages alleging " wrongful life ". It is an unusual concept but it has made a lot of money for lawyers.

The basis of the claim is a child born with severe disabilitiesshould not have been allowed to live - the child should have been aborted. Consequently the parents of that disabled child can sue for damages.

This question recently seems to have been finally settled in Australia at least. The Australian High Court has ruled that children born with deformities which were not detected during pregnancy cannot sue for damages. This case involved a profoundly disabled child born to a mother who contracted German Measles during pregnancy.

The court decided it could not determine whether the alternative of being aborted during pregnancy was a better or worse outcome for that child. The court further decided it was an impossible task to compare life with a disability with no life at all.

Youth and Driving Skills and Road Accidents
One of the most significant Public Health Issues is Road Traffic Accidents (RTA): World wide there are about 750,000 - 880,000 RTA deaths per year.

Asia contributes about 45% of those deaths.

During the annual week long “Water Festival” in Thailand there are about 700 deaths and 30,000 injuries from road traffic accidents.Most of these are alcohol and motor bike related accidents.

In West Australia drivers aged 17 -24 years cause 30% of fatalities and 30% of hospital admissions from road traffic accidents.Probationary drivers are involved in crashes at triple the rate of more experienced drivers.

Much more stringent restrictions on young drivers in Australia are coming in 2008